As people approach and reach the end of life they, their families and carers are required to navigate increasingly complicated care systems to address their needs.
Current patient journeys are often poorly coordinated and this is particularly true for people with advanced chronic disease who have multiple comorbidities and a much slower and more unpredictable trajectory of functional decline (ACI, 2015). The needs of people, their families and carers during their end of life journey vary over time and care setting, meaning services need to be responsive, coordinated and flexible in meeting these changing needs.
It has been demonstrated that navigation support and or care coordination improves clinical outcomes and the experience and satisfaction of patients, families and carers.
A strong collaborative approach to care has been shown to not only increase patient satisfaction, patient care quality and optimise the use of finite resources, but is also likely to reduce errors, limit gaps in care and lessen unnecessary treatments and hospitalisations (NSW Health, 2019; Palliative Care Australia, 2018).
Provision of safe healthcare requires a synergistic approach with an emphasis on shared case management, effective communication, data sharing and teamwork between multidisciplinary professionals across all healthcare settings. A lack of continuous collaborative care is a contributing factor in adverse patient events (NSQHS, 2017).